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Page 2 <br /> <br />FOOD VENDOR PERMIT APPLICATION <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food-preparation utensils:11. <br />12. <br />13. <br />Completed by:.14. <br />Health Permit10X10 ft Booth No Smoking Sign <br /> Bleach <br />Bleach and WaterSoap and Water <br />Ice Cooler <br />Page 2/2 Rev 10/14/2015 <br />■ _______________________ <br /> A-* <br />Extra Ice t <br />ofthegroc <br />Food Cont / oT"" <br />Stemo w/Chaffing <br />Dish <br />□ Refrigerator <br />Qd'ce bath and tubs <br />Garbage <br />Can <br />Must be on <br />Concrete, Asphalt, <br />Plywood or a Tarp <br />5 Gal Hand Wash <br />Waste Water Container <br />2-1/2 GaJ. <br />Hand Wash Water <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45° F: <br />Extra <br />Water <br />Your hot & cold food temperatures will be monitored. Your hand washing and sanitation processes will <br />be checked. PLEASE meet the required standards as addressed herein. <br />Ice chests <br />□ Refrigerated truck <br />□ Other (specify): <br />Bags must be stored oft <br />-------.oundl <br />■ood Containers must be stored <br />iffthefloorl <br />vendors@SanJoaquinAs|jaragusFestivaLnet • 916-370-3647 phone • 209-234-1780 fax <br />Fire Extinguisher I <br />I Soap Dispenser <br />□ Three compartment sink. <br />deep tubs (basins 6-8 inches minimum), one for soapy water, the other for rinse and bleach solution. <br />J^Detergent, bleach and water (one cap full per gallon of water). <br />I am providing the following for adequate hand washing facilities, but separate from utensil washing <br />within my booth: <br />Propane Tank <br />___ <br />IMPORTANT . . . <br />All food vendor booths are subject to inspection. Please make yourself a copy of this application in preparation for this <br />event. A copy of this checklist must be in the booth at all hours of preparation and operation. <br />Return original to festiyaFeqordinator two months prior to this event. <br />k _ <br />JpfWater supply dispenser (e.g. 5-20 gallons, Igloo or Coleman container with spigot). <br />J^One separate tub (bucket or basin) for the collection of rinse/waste water. <br />p-'Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />/7Wi/ZLzf _______-_____________ <br /> <br />Paper Hand Towels I